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Obsessive face picking

Dear Alice,

My girlfriend has a terrible obsession with picking her face. It is not that she has bad skin or acne, but, when she is in a certain state, she will stand in front of the mirror for hours and pick her face to shreds. It leaves her with horrible sores and open cuts covering her face. One day, she will be fine, and the next day, she will look like a war casualty. After she does this, she feels that she has to hide for days.

Aside from these concentrated sessions in front of the mirror, she is constantly picking her face while she is studying or reading or talking on the phone. Often, the state of her picked face affects our plans -- for example, she may not come with me to see my family even though we had planned to go together. When she is particularly self-conscious about it, she forbids me to look at her. She will cover her face with her hand or hair if I am even gazing anywhere near her. It is hard to communicate when I cannot see her face, and it affects our kissing and other intimacy.

We are very close and have been together for two years. We have talked about this many times and it does not seem like there has been any change. Mostly, I have been supportive by listening to her and comforting her. But, at times, I have been upset and have let her know. Some of her family members do not hesitate to be cruel to her when she "looks like shit." But she is well aware of her problem, but cannot seem to stop. She has had this obsession for over three years, and it is really making her miserable, and is making me wonder if it will ever go away on its own.

We have talked about the possibility of some kind of therapy, but she does not feel that it could help. She seems to be terrified of having to see any kind of therapist. I feel that somewhere inside, she needs to stay feeling miserable even though she is clearly genuine when she is cursing the terrible life this habit makes for her.

I have every intention of staying with her, but I feel that her obsession and the self-consciousness and misery that come with it are keeping us from getting closer. How can I have more of a role in affecting some kind of change in this? I feel that there are things that I have no control over, but they affect me and the one I love deeply.

—No pock marks

Dear No pock marks, 

Your concerns for your girlfriend are valid — it can be difficult to watch someone you love go through physical and emotional pain with an experience you feel you have no control over. Skin picking disorder is a psychological disorder recognized by both the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the International Classification of Diseases (ICD-11). As with many mental disorders, the experiences of those with the disorder and the people close to them can be particularly distressing. You mention that she is terrified to see a therapist — many people with skin picking disorders may feel self-conscious about facing judgment for their behaviors. Perhaps you could offer to accompany her to a session, if you’re both comfortable with that. You may even suggest she speak with a health care provider or dermatologist (a doctor who specializes in skin, hair, and nail conditions) to speak about treatment options for her face after picking. It may also help to educate yourself on skin picking disorders so that you feel better able to help your girlfriend when she goes through a picking episode. Read on for more information! 

Skin picking disorders, also known as excoriation or dermatillomania, are classified as an impulse control disorder closely related to obsessive compulsive disorder (OCD). In fact, many folks who have a skin picking disorder also qualify for an OCD (or similar) diagnosis. Skin picking disorders may also be referred to as “body focused repetitive behavior” (such as hair pulling or trichotillomania) because their actions are often in response to specific urges to touch at or pick skin. You mention that your girlfriend picks at her face; while that is a common area for skin picking, some people may pick at other parts of their head, nails, hands, feet, arms, or legs. People with skin picking disorders may feel an impulse to pick at their skin for many reasons — anxiety, stress, negative emotions, hunger, or boredom. In fact, some people might not even be aware of their picking habits! It’s worth mentioning that not everyone who picks at their skin has a disorder. In fact, it’s a pretty common action, and a lot of people occasionally pick at their skin, whether it’s pimples, scabs, peeling skin, cuticles, or even healthy skin. It only becomes a disorder when: 

  • Someone routinely picks their skin and has difficulty stopping 
  • Their skin picking starts to cause permanent damage to their skin 
  • They experience negative feelings after picking their skin, such as extreme guilt or shame 

The exact causes of skin picking disorder are still unclear. However, one study looking at brain activity in people with skin picking disorder identified that there may be a link between impulse control and skin picking. Specifically, for folks with skin picking disorders, the parts of the brain responsible for monitoring impulse control function differently than those of people who don’t have the disorder. This may explain why someone with skin picking disorder has difficulty with stopping picking, even when they have the desire to stop. 

While more research is needed on treatments for skin picking disorders, there are some treatments that have been shown to be effective in reducing the symptoms of the disorder. For example, talk therapy methods such as cognitive behavioral therapy (CBT), habit reversal therapy (HRT), and acceptance and commitment therapy (ACT) may help identify thoughts and situations that trigger skin picking urges and offer less damaging alternatives when experiencing those urges, such as clenching fists. If therapy isn’t a viable option, perhaps pharmacological interventions could be of use. Selective serotonin reuptake inhibitors (SSRIs), commonly prescribed for people with depression, may help target intrusive thoughts to trigger compulsive skin picking behaviors. In the meantime, your girlfriend might find it helpful to get a consultation with a health care provider or dermatologist to discuss treatments for any skin damage. 

No pock marks, you mention that your girlfriend’s family “doesn’t hesitate to be cruel” to her. Have you noticed that she picks her skin in anticipation of seeing her family or after she interacts with them? It may be helpful to sit down with her and help identify if there are any triggers that give her the desire to pick at her skin, whether it’s family, work/school, or certain social situations. Does she experience a lot of stress in her daily life? Perhaps activities such as yoga, journaling, or physical activity may help manage her stress and reduce triggers. By identifying and managing triggers, you may both feel like you have more control over the situation. It’s worth noting these strategies aren’t meant to be replacements for evidence-based treatments; however, they might help you and your girlfriend manage her symptoms on a day-to-day basis. 

Asking for more information is a great first step to help support your girlfriend and her skin picking. While information is provided here, it’s no replacement for speaking with a mental health professional or health care provider to receive a proper diagnosis and create a treatment plan. You may also consider seeking out a mental health professional for yourself to discuss your own experiences and feelings regarding your girlfriend’s skin picking. For additional information about other obsessive behaviors, you can check out the Go Ask Alice! Obsessive & Compulsive Behavior archives. 

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Last updated Sep 17, 2021
Originally published Nov 01, 1994